The Prevalence of Burnout and Its Predictors among Pharmacists Working in Government Hospitals in Selangor

@#Introduction: To determine the prevalence and predictors of burnout (personal, work-related and client-related) among pharmacists in government hospitals in Selangor. Methods: An analytical cross-sectional study was conducted among 376 pharmacists working in five government hospitals in Selangor. The data was collected via email using Google form containing self-administered questionnaires. Frequency and percentage of variables were obtained using descriptive statistics. Chi square was utilized to identify the relationship between factors. The significant predictors were determined using multiple logistic regression analysis. Results: Prevalence of burnout among pharmacist was reported as 52.9% (Personal), 66.0% (Work-related) and 47.1% (Client-related). The significant predictors of personal burnout were gender (AOR 2.24, 95% CI 1.29 to 3.89), working hours per week (AOR 2.92, 95% CI 1.60 to 5.32), job satisfaction (AOR 13.00, 95% CI 3.37 to 50.16) and depression (AOR 3.33, 95% CI 1.98 to 5.61). The significant predictors of work-related burnout for male was from work stress (AOR 9.10, 95% CI 3.12 to 26.60) and anxiety (AOR 5.91, 95% CI 2.03 to 17.25) while for female was from anxiety (AOR 5.91, 95% CI 2.86 to 12.23) and self-esteem (AOR 5.88, 95% CI 1.68 to 20.56). For client-related burnout, working hours per week (AOR 2.44, 95% CI 1.39 to 4.28), job satisfaction (AOR 3.91, 95 % CI 1.49 to 10.27) and anxiety (AOR 2.61, 95% CI 1.57 to 4.32) were the significant predictors. Conclusion: Burnout among pharmacists is crucial to be brought to highlight and it is necessary to perform appropriate interventions for managing the burnout.

Effectiveness of a Pelvic Floor Muscle Exercise Intervention in Improving Knowledge, Attitude, Practice, and Self-Efficacy among Pregnant Women: A Randomized Controlled Trial / 가정의학회지

Background@#The awareness and practice of pelvic floor muscle exercise (PFME) in the prevention and reduction of the rate of urinary incontinence among pregnant women was considerably poor, despite the increased prevalence of urinary incontinence during pregnancy across Malaysia. There healthcare providers do not give adequate attention to the potential impact of PFME on urinary incontinence and there is limited local intervention addressed urinary incontinence during pregnancy. The objective of this study was to determine the effectiveness of a newly developed PFME intervention in terms of knowledge, attitude, practice, self-efficacy, and urinary symptoms. @*Methods@#A single-blinded, two-armed, randomized control trial was included pregnant women from 18 to 20 weeks of gestation and was conducted at the Maternity Hospital of Kuala Lumpur. The intervention group received PFME in addition to the usual perinatal care. The data were collected using validated questionnaires at 4 time points: baseline, post-intervention in the early third trimester, late third trimester, and early postnatal period. The intervention effects were analyzed using a generalized estimating equation. @*Results@#The primary analysis included pregnant women who had at least one follow-up; 122 women (71.8%) in the intervention group had significant improvement in knowledge, attitude, practice, and self-efficacy, as well as in the severity of urinary incontinence over time. However, improvement was not observed in self-reported urinary incontinence. @*Conclusion@#PFME can be considered an effective initial intervention to provide information about urinary incontinence prevention to pregnant women.

Effectiveness of an integrated-Weight Management Programme (i-WMP) in Reducing Body Weight among Noncommunicable Disease Patients in Malaysian Government Primary Care Clinics: A Randomised Controlled Trial

@#Introduction: Obesity is a global issue called as “globesity”. Overweight and obesity may lead to many noncommunicable diseases (NCDs). Primary care is the first centre to monitor and follow-up the progress of NCD patients. Therefore, the objective of this study was to determine the effectiveness of an integrated-Weight Management Programme (i-WMP) to reduce body weight among NCD patients from two Government primary care clinics from Hulu Langat District. Methods: This study was single-blinded randomised controlled trial by design. There were 244 eligible patients were randomised into intervention (n = 122) or wait-list control group (n = 122). The i-WMP was developed based on the behaviour change wheel through the operationalization of behaviour change techniques. The duration of this intervention programme was four weeks. Data collected at week 0, week 4, and week 12. The software IBM SPSS was used to analyse the data. Generalized linear mixed model analysis with intention-to-treat principle was applied. Results: The retention rate was 74.2%. Findings showed that the i-WMP was significantly effective in reducing not only body weight as primary outcome but also secondary outcomes such as waist-to-height ratio, waist circumference, body mass index, and total sitting time. It also improved effectively other secondary outcomes such as participants’ knowledge, attitude, and practice towards dietary and towards physical activity. However, no significant changes were reported for body fat percentage and total physical activity metabolic equivalent of task-minutes/week. Conclusion: Implications surrounding the implementation of i-WMP in the primary care clinics are recommended.

From the MJM Editors’ Desk: Common errors authors make in submission to the Medical Journal of Malaysia

@#Proper understanding the ‘Instructions to authors’ for a particular journal is the key towards successful submission of a manuscript which will lead to it being published. Common errors that are frequently made by authors in their submission to the Malaysia Journal of Malaysia (MJM) that lead to rejection of their submission or requiring major revisions or minor revisions are listed and discussed in this article. Outright rejection prior to even a peer review process may be made for an article due to: it is poorly written or when there is suspicion on the authenticity of the submission, which contains elements that are suspected to be plagiarised, it is a duplicate submission or not in the format required by the MJM. The editor in charge of the issue makes a recommendation to the Editor in Chief for the final decision.

Self-esteem among cancer patients receiving chemotherapy in selected government state hospitals, Peninsular Malaysia

@#Introduction: The number of cancer cases in Malaysia has increased from 32,000 cases in 2008 with to 37,000 in 2012 (check figures in text). This number is expected to rise to 56,932 by 2025. Cancer patients undergoing chemotherapy experience low to moderate level of self-esteem. Objectives: To determine the self-esteem among oncology patients receiving chemotherapy in selected government state hospitals, Peninsular Malaysia. Methods: A cross-sectional study was conducted using selfadministered questionnaires. 953 respondents were given questionnaires which included socio-demographic profile, physical effect, depression, anxiety, quality of life and self esteem. Inferential analysis was done by using Independent T-test or Pearson’s Correlation and the level of significance was p<0.05. Multivariate logistic regression was then used to determine the predictors using Statistical Package for Social Sciences software version 22.0 Results: All 953 respondents selected participated in this study. The overall mean self-esteem in this study was 22.67, SD=4.98. The significant predictors of self-esteem where pvalue was <0.05 were age; gender; marital status; working status; anxiety; depression; nausea; anemia; hair loss; skin and nail changes; overall quality of life and psychological domain of quality of life. The finding of this study indicates that predictors of selfesteem among patients undergoing chemotherapy should be taken into account to improve their quality of life. Guidelines on how to manage self-esteem in a chemotherapy patient can be done using this study as the baseline

Knowledge, Attitude and Preventive Practices Regarding Tuberculosis and Its Predictors among HIV Patients in General Hospital, Minna; North-Central; Nigeria

@#Introduction: Tuberculosis is the commonest cause of death among HIV patients in Nigeria. Though tuberculosis is common among HIV patients, their knowledge about transmission and prevention is poor. Objective: To determine knowledge, attitude and preventive practices regarding tuberculosis and its predictors among HIV patients receiving treatment. Methods: A cross sectional study was carried out involving 226 randomly selected HIV patients receiving care at General Hospital, Minna. Study duration was from June 2015 to July 2017. Data on socio-demographic characteristics, psychosocial factors, knowledge, attitude and preventive practices regarding tuberculosis was collected using a self-administered, WHO modified, pretested and validated questionnaires. Data collected was analysed using SPSS version 22. Results: Out of 226 respondents, 60(26.5%) had poor knowledge, 123(54.4%) had negative attitude and 48(21.2%) had poor preventive practices regarding tuberculosis. The predictors of knowledge were age (B=0.087, 95%CI=0.031, 0.143, p=0.002), depression (B=-0.444, 95%CI=-0.673,-0.214, p<0.001) monthly income (B=-0.058, 95%CI=-0.095, -0.021, p=0.002) and marital status (B=-1.276, 95%CI=-2.525,-0.025, P=0.046). The predictors of attitude were anxiety (B=-0.395, 95%CI=-0.584, -0.206, p<0.001), cigarette smoking (B=4.473, 95%CI=0.992, 7.954, p=0.012) and duration of HIV infection (B=0.371, 95%CI=0.110, 0.631, p=0.005). The predictors of practice were depression (B=-0.176, 95%CI=-0.276, -0.076, p=0.001), cigarette smoking (B=2.200, 95%CI=0.926, 3.474, p=0.001) and duration of HIV infection (B=0.098, 95%CI=0.003, 0.194, p=0.043). Conclusion: Overall, knowledge and practices regarding tuberculosis prevention were good, but attitude was poor. The predictors of knowledge, attitude and preventive practices were age, depression, anxiety, cigarette smoking, monthly income, marital status and duration of HIV infection.

Prevalence and Predictors of Water Pipe (Shisha) use among Iranian High School Children

Introduction: Water pipe use is becoming increasingly common among Iranian adolescents. This study examined the prevalence and predictors of water pipe use among public high schoolchildren aged 14-17 in Iran. Methods: A cross-sectional study was conducted among 1st, 2nd and 3rd grade public high schoolchildren in Sanadaj City, capital of Kurdistan province of Iran during the academic year 2012-2013. Cluster sampling was used to select a sample from 8 public high schools. The data were collected using validated self-administrated questionnaire that included questions on water pipe use, socio-demographic characteristics, smoking-related knowledge, attitude toward smoking, normative believes regards perceived prevalence water pipe use among peer and adults, perception of harm, self-esteem and refusal skill. A multivariate logistic regression analysis was performed to assess predictors of water pipe use. Results: A total of 1837 students participated in this study. Students’ ages ranged from 14 to 17 years (mean age±15.09; SD±0.82 years). The overall prevalence of ever water pipe use was 36.2% (43.1% in male and 29.2% in female, (p<0.001). Age, gender, living arrangement, pocket money, academic grade, parental history of smoking, attitude, and normative believes regards perceived prevalence water pipe use among peer and adults were predictors of water pipe use among study participants. Conclusions: The overall prevalence of water pipe is high among high school children in Sanandaj. Age, gender, pocket money, academic grade, parents smoking, attitude toward smoking and normative believes were identified as the most important predictors increasing the risk of water pipe use in the studied students.

Outcome of chemotherapy counseling by pharmacists on psychological effects and self esteem among oncology patients in a Government Hospital in Malaysia

SUMMARY Introduction: Chemotherapy is the most common form of treatment among cancer patients. It is also known to cause many physical and psychological side-effects. Objective: This study developed, implemented and evaluated the outcome of a chemotherapy counseling module among oncology patients by pharmacists based on their psychological effects (depression, anxiety) and selfesteem. Methods: A randomized, single blind, placebo controlled study was conducted among 162 patients undergoing chemotherapy in a government hospital in Malaysia. Intervention: Counseling sessions were conducted using the 'Managing Patients on Chemotherapy' module for oncology patients undergoing chemotherapy at each treatment cycle. Outcome: The outcome of repetitive chemotherapy counseling using the module was determined at baseline, first follow-up, second follow-up and third follow-up. Results: The findings revealed that there was significant improvement in the intervention group as compared to the control group with large effect size on depression (p = 0.001, partial Ƞ 2 = 0.394), anxiety (p = 0.001, partial Ƞ 2 = 0.232) and self-esteem (p = 0.001, partial Ƞ 2 = 0.541). Conclusion: Repetitive counseling using the ‘Managing Patients on Chemotherapy’ module was found to be effective in improving psychological effects and self-esteem among patients undergoing chemotherapy.

Prevalence and Predictors of Suicidality Among Medical Students in A Public University

Background: Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others. Objective: This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university. Methods: This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21). Results: Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent’s lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9). Conclusion: These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.

Knowledge and attitudes of adult HIV positive patients to HIV/AIDS in Selected ART Clinics in Yola, Nigeria

Though cases of AIDS are visible in Nigeria and awareness of HIV is high, correct knowledge on HIV transmission and prevention has remained low with significant numbers of people living with HIV/AIDS having low attitudes towards life and the disease itself. This study determined the baseline knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS of adult HIV positive patient enrolled into care at all four comprehensive antiretroviral therapy (ART) sites in Yola, Nigeria. Baseline reports on the knowledge and attitudes of adult HIV positive patients were obtained from a three arm randomized single blind clinical trial involving 386 randomly selected adult HIV patients who were enrolled into ART care at all four comprehensive ART sites in Yola. An administered, validated structured questionnaire was used for data collection. Outcome measures were sound knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS. Data was analyzed using SPSS version 22. Test of significance was at α level 0.05. Overall 237 (61.4%) had sound knowledge on HIV transmission and prevention, while 346 (89.6%) of respondents had high attitudes towards HIV/AIDS. Though majority of respondents had sound knowledge on HIV transmission and prevention as well as high attitudes towards HIV/AIDS, interventions to improve knowledge and attitudes among this group of individuals would improve positive preventive strategies.

Reliability and Factor structure of the General Health Questionnaire-12 among university students

Introduction: The 12- item General Health Questionnaire (GHQ-12) has been translated into many languages and widely used in different settings and countries. Its reliability and psychometric properties were extensively studied in many population groups which suggested that it measures psychological distress in multidimensional construct. Objective: The objective of this study was to assess the reliability and factor structure of the Bahasa Malaysia version of the GHQ-12 among university students attending a health program at a Malaysian public university. Method: The cross sectional survey was conducted on 306 undergraduate students aged between 18 to 27 years old who visited the booth set up for mental health screening at a health program. The screening was conducted using a self-administered, validated Bahasa Malaysia version of GHQ-12 questionnaire. Results: Using exploratory factor analysis, the Bahasa Malaysia version of GHQ-12 was found to have a three factor structures namely depressive symptoms, self-esteem and perceived abilities which accounted for 58% of the item variance. The overall Cronbach’s alpha coefficient of the scale was found to be high (0.84) with each factor having acceptable inter-item consistency ranging from 0.61 to 0.82. Conclusion: The findings of the study show that the Bahasa Malaysia version GHQ-12 is reliable and has good structural characteristics. It can assess a few domains of the psychological status of university students. It also helps in providing more information on the domain which may become a focus target of intervention in the prevention of mental illness.

Prevalence and Contributing Factors of Job Strain among Crane Operators in a Port Container Terminal in Malaysia

The information on job strain among crane operators in Malaysia is lacking. The aim of this study was to determine the prevalence and contributing factors of job strain among crane operators working in port container terminals. A cross sectional study was carried out at a port container terminal in Malaysia. Data was collected using validated self-administered questionnaires, which consisted of the Job Content Questionnaire (JCQ), and the Depression, Anxiety, and Stress Scale (DASS-21). All crane operators in the selected terminal participated in the study. Data was analyzed using SSPS version 19. Two-hundredand-forty crane operators participated in the study.. The prevalence of job strain determined from the JCQ was 43.8%. Job strain was significantly associated with psychological job demand, decision latitude, anxiety, physical isometric loads and muscle ache. The prevalence of job strain in this study was high. There is an urgent need to recognize the existence of this problem among crane operators by their respective management. Implementation of comprehensive stress management programs are recommended to reduce job strain among these workers. Keywords:I

Prevalence of obesity and associated factors among secondary school students in Slemani City Kurdistan Region, Iraq

Introduction: Obesity is a well-established risk factor for cardiovascular disease. The objective of the study was to determine the prevalence of obesity and factors associated among secondary school students aged between 13 to 17 years at Slemani City Centre, Iraq. Methodology: A cross sectional study design was used. The calculated sample size was 1656. Probability proportional to size sampling technique was used to select the sample. A validated pretested questionnaire was used to collect the data. Weight and height were also taken. Data were analyzed using SPSS version 21. Chi-square test was used to determine an association between two categorical variables. Independent t-test was used to compare two means. Multiple logistic regression was used to determine the predictors for obesity. Results: The response rate was 92.54% and the overall mean age of the 1588 respondents was 15.42 (95% CI = 15.35, 15.49) years. The prevalence of overweight and obesity was 20.6% and 11.3% respectively. Variables significantly associated with overweight and obesity (age, monthly family income, education level of parents, body part satisfaction and body size perception) were entered into the logistic regression model. Multiple logistic regression analysis showed that the predictors for overweight and obesity were age, monthly family income, body part dissatisfaction and body size perception. Conclusion: The prevalence of overweight and obesity is high (20.6% and 11.3% respectively). The predictors of obesity among secondary school students aged between 13 to 17 years old at Slemani City Centre Kurdistan Region, Iraq were age, family income and body image dissatisfaction.

Prevalence of depression among women attending a primary urban care clinic in Malaysia

<p><b>INTRODUCTION</b>Depression affects more women than men in Malaysia. The objective of this paper was to determine the prevalence of depression and its associated factors among women attending a government primary care clinic.</p><p><b>METHODS</b>A cross-sectional study was conducted in a government-funded primary care clinic in Malaysia. Consecutive adult female patients attending the clinic during the data collection period were invited to participate. The participants completed self-administered questionnaires (including the validated Patient Health Questionnaire [PHQ-9], which was translated into the Malay language).</p><p><b>RESULTS</b>A total of 895 female patients participated in the study (response rate 87.5%). The prevalence of depression (PHQ-9 scores ≥ 10) was 12.1%. Based on multiple logistic regression analysis, certain stressful life events were found to be associated with depression (p < 0.05). These factors, arranged from highest to lowest risk, were financial problems (odds ratio [OR] 3.7, 95% confidence interval [CI] 2.2-6.2), unhappiness in the parent-child relationship (OR 3.0, 95% CI 1.2-7.5), history of serious illness (OR 2.4, 95% CI 1.1-5.2), unhappiness in family relationships (OR 2.3, 95% CI 1.1-4.7) and unhappiness at work (OR 2.2, 95% CI 1.1-4.3) (p < 0.05).</p><p><b>CONCLUSION</b>The prevalence of depression among participants in this study was clinically significant and corresponded with the findings of other international studies. Factors associated with depression need to be highlighted and addressed accordingly. Clinicians in Malaysia should be aware of this prevalence when making diagnoses in primary care.</p>

The Prevalence of Urinary Incontinence among the Elderly in a Rural Community in Selangor

Background: Urinary incontinence is a common but poorly understood problem in the elderly population. The aim of this study was to determine the prevalence of urinary incontinence and its associated factors among the elderly in a community setting. Methods: A cross-sectional study design was used. Stratified cluster sampling was used in this study. All elderly residents aged 60 years old and above who fulfilled the selection criteria were included as respondents. The translated Malay version of the Barthel’s Index (BI) was used to identify the presence of urinary incontinence. Results: The prevalence of urinary incontinence was 9.9% among the elderly respondents. Urinary incontinence among the elderly was significantly associated with age, gender, depression, functional dependence, and diabetes mellitus (P < 0.05).

Prevalence of overweight among secondary school students in Klang district, Selangor

Overweight and obesity place children and adolescents at increased risk of significant health problems, both during their early life and adult life. A crosssectional study was carried out to determine the prevalence of overweight among secondary school students aged 13-17 years in the Klang district and to determine the association between overweight and age, sex, ethnicity, religion and blood pressure. Random cluster proportionate to size sampling technique was used to select the respondents. Weight was recorded using TANITA model HD-309 and height was measured using SECA Body meter Model 208. A mercury sphygmomanometer was used to measure blood pressure manually. Statistical analysis was carried out using SPSS version 13. Out of the 3,333 respondents, 11.4% were found to be at risk of overweight and 8.2% were overweight. The prevalence of overweight was significantly higher in the males (10.6%) as compared to females (6.0%). Prevalence of overweight was highest in Malays (10.7%) followed by the Indians (7.1%) and the Chinese (5.9%). Prevalence of ‘risk of overweight’ was highest in the Indians (13.7%) followed by Chinese (12.0%) and Malays (9.8%). There was a moderate direct significant relationship between overweight and systolic blood pressure (r=0.5, r2=0.25, p<0.001) and also diastolic blood pressure (r=0.42, r2=0.18, p<0.001). The relationship between BMI and overweight was very weak (r=0.11, r2=0.01 and df=3331, p<0.001). In conclusion the prevalence of overweight among the secondary school students is high and there is a need for a comprehensive integrated population-based intervention program.